Stress Management: Change the Controllable and Manage the Uncontrollable Stressor

By: Sonal Patil, MD • Posted on December 07, 2022

What is stress?

Stress is a normal protective response to threats. When someone confronts an oncoming truck or a danger, the brain sends signals to the body for self-protection, known as the body’s natural fight or flight response. Acute stress responses are due to increased sympathetic nervous system activation, whereas chronic stress results from hypothalamic pituitary axis activation, which leads to increased cortisol production. When the fight and flight response is out of proportion to the threat present, it turns into an anxiety disorder. Stress and anxiety disorders are more common in women than in men.

How does stress affect health?

Sympathetic nervous system activation during acute stress can increase:

Increase blood pressure
Increase heart rate
Cause adverse heart events¹

Chronic stress response leading to increased cortisol can lead to increased glucose levels leading to prediabetes or diabetes.² Additionally, stress can trigger unhealthy behaviors such as smoking, emotional eating, and heart disease risk factors.³

Can you prevent stress?

Stress is an inevitable part of life. It can be easier to handle small stressors, but they can pile up with time. Additionally, significant adverse life events can seem debilitating. Stress management is a necessary skill for optimal functioning.

What can help with stress management?

Recognize and normalize your stress responses:

Everyone has different stress responses, so it is important to focus on what you notice about your body, feelings, thinking, and behaviors.
Once you understand your normal stress responses, condition yourself to know when they are unnecessary, such as in conditions that are no longer threats or danger or of minor consequences.

Recognize what is in your control and what is not:

Thinking about stressful issues, try to compartmentalize what is controllable and not.
Examples of controllable things are: safe driving, bedtime, wake-up time, hugging your loved ones and showing up on time.
Examples of what is not controllable are: other people’s actions, weather, construction and politics.

Change controllable and manage uncontrollable stressors:

For controllable stressors, make a change! Get information and advice followed by making action plans and decisions to reduce the effect of controllable stressors.
For uncontrollable stressors, develop coping skills to manage emotions and their effect on your health. Online and phone apps for meditations, guided imagery and progressive muscle relaxation are useful strategies. Seeing a professional therapist can be very helpful.

Relationships can be a big source of support or stress:

Connect and grow supportive relationships.
Set limits or distance from stressful relationships.

Stress can affect your heart, relationships and health. Regular physical activity, healthy eating, adequate sleep, and relaxation strategies can prevent the negative effects of stress on your health.⁴

When dealing with a stressful issue, simply ask yourself – Is it worth it?

Cleveland Clinic Center for Integrative and Lifestyle Medicine has shared medical appointment programs that encompass medical strategies with coping skills training to improve health and holistic psychotherapy counseling. To make an appointment, call 216-448-4325.

Meditation is also a helpful tool for handling stress. Mindful Moments is a free Cleveland Clinic app with guided meditations of varying lengths.

Be Strong, Be Healthy, Be in Charge!
-Sonal Patil, MD, MSPH

About Sonal Patil, MD

Dr. Sonal Patil is a family physician and health services researcher. Dr. Patil’s research interests include inter-professional team member interventions, hypertension self-regulation, and improving cardiovascular health disparities in primary care settings.

Dr. Patil earned her medical degree from North Maharashtra University and was an OB/GYN resident at a public hospital in India before moving to the US. After completing her Family Medicine residency at the Emory Family Medicine Residency program, she worked at Kaiser Permanente in Georgia and East Boston Neighborhood Health Center. Dr. Patil completed post-graduate coursework in the Principles and Practice of Clinical Research (PPCR) in 2013, then offered by Harvard Medical School. After completing an academic fellowship at the University of Missouri, Dr. Patil earned her MSPH degree in 2016. Before moving to the Cleveland Clinic, Dr. Patil was an assistant professor in the Department of Family and Community Medicine at the University of Missouri. Dr. Patil has worked on several interdisciplinary collaborative projects as well as collaborated with local public high schools. Dr. Patil was selected as the NIMHD Health Disparities Research Institute scholar in 2019. Dr. Patil was an ICTS scholar in the Washington University ICTS KL2 Career Development Awards Program before joining the Cleveland Clinic Department of Wellness and Preventive Medicine.

References:

Motiejunaite J, Amar L, Vidal-Petiot E. Adrenergic receptors and cardiovascular effects of catecholamines. Annales d'Endocrinologie. 2021/06/01/ 2021;82(3):193-197.
Harrell CS, Gillespie CF, Neigh GN. Energetic stress: The reciprocal relationship between energy availability and the stress response. Physiol Behav. Nov 1 2016;166:43-55. doi:10.1016/j.physbeh.2015.10.009
Vaccarino V, Shah AJ, Mehta PK, Pearce B, Raggi P, Bremner JD, Quyyumi AA. Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient. Atherosclerosis. Jul 2021;328:74-82. doi:10.1016/j.atherosclerosis.2021.05.020
Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:doi:10.1161/CIR.0000000000000947

women's health, stress, stress management, blood pressure, stressors, controllable stressors, uncontrollable stressors, heart health, meditation

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